Contraception coverage finalized

The Obama administration on Friday finalized its health care reform policy requiring nearly all employers to provide coverage of contraceptives in their employee health insurance policy free of co-pays, digging in its heels against backlash from religious groups.

The “safe harbor” agreement that gave temporary reprieve from the requirement to religious universities and hospitals was due to expire in just a month. But the administration on Friday extended that to January.

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Otherwise, the policy — a piece of the president’s health care reform law — changed little since an earlier draft and continues to face opposition from religious groups that say it requires them to choose between their religious beliefs and government fines.

The final release of the rules Friday is likely to unleash more than two dozen lawsuits that were put on hold as the government finished its policy. Dozens of other lawsuits on the issue are already moving, and it’s expected to reach the Supreme Court.

Under the rules, only religious employers as defined by the Internal Revenue Code are exempt.

Religious-affiliated institutions, such as universities, won’t be exempt, but they can use a more streamlined process to get an insurance company to cover the contraceptives rather than doing so directly. If they object to covering contraception, they can use their insurer — or third-party administrator — to find the coverage for them.

Self-insured health plans — usually of large employers — can notify a third-party administrator in the same way.

HHS says this pathway ensures the business owners don’t have to arrange or pay for the drugs against their beliefs while ensuring women have access to preventive care. The policy’s opponents don’t agree.

They say the new rule changes nothing and that the government is still forcing them to be the “gatekeepers of abortion.” They argue that the requirements force them to provide contraceptives as well as drugs that they say cause abortions.

“This is more of the same,” said Eric Rassbach, deputy general counsel at the Becket Fund for Religious Liberty, which is representing several of the institutions challenging the policy in court. “HHS tinkered with some of the mechanisms in the rule to deal with specifically under the [employer health coverage] benefits law, but it didn’t really get at the fundamental religious conscience questions.”

Rassbach predicted that several more lawsuits could be filed soon.

And employers with no religious affiliation still have no recourse to block contraception in their policies if their owners hold religious beliefs against the use of contraception. They must provide the coverage or pay penalties. The owners of Hobby Lobby craft stores, which Becket is representing, are among the nonreligious employers who have filed suit on the policy.

The Obama administration said it received more than 400,000 comments on the proposed policy, which has gone through several changes amid opposition. But HHS held firm to what it says drove Congress to include the coverage in the law in the first place: promoting public health.

The administration argues that the coverage reflects a “determination by Congress” that preventive care is necessary “to achieve access to basic health care for most Americans.” People are more likely to use preventive services if there is no co-pay, the administration wrote in the rules.

Preventive care can ensure that women can space pregnancies far enough apart to keep their children healthy, avoid unplanned (and thus possibly less healthy) pregnancies and provide health benefits unrelated to pregnancy, such as preventing certain cancers or acne. The administration also says that contraception reduces the number of women seeking abortions.

Women’s health groups praised the policy.

“This is a historic moment for women’s health and economic security,” said Cecile Richards, president of Planned Parenthood Federation of America. “Birth control is basic health care for women, and this policy treats it like any other kind of preventive care. … It’s appalling that we still have to fight for access to birth control in 2013.”